Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Cause | Clinical Features | Investigations | Management |
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Central (True) Precocious Puberty (e.g., Idiopathic, CNS Tumours) |
Early development of secondary sexual characteristics, growth acceleration, advanced bone age, headaches or visual disturbances if CNS tumour is present. | Serum LH and FSH (elevated), MRI of the brain (to rule out CNS tumours), bone age assessment, pelvic ultrasound (in girls). | GnRH analog therapy to delay further pubertal progression, monitoring growth and development, surgical resection if a CNS tumour is present. |
Peripheral (Precocious Pseudopuberty) (e.g., McCune-Albright Syndrome, Adrenal Tumours) |
Asymmetric development of secondary sexual characteristics, café-au-lait spots (in McCune-Albright), virilization in girls, advanced bone age. | Serum estradiol/testosterone (elevated), adrenal imaging (CT or MRI), bone age assessment, genetic testing for McCune-Albright syndrome. | Treatment of the underlying cause (e.g., surgical removal of adrenal tumours), anti-estrogen or anti-androgen therapy, management of associated symptoms. |
Congenital Adrenal Hyperplasia (CAH) | Early development of pubic/axillary hair, rapid growth, virilization in girls, salt-wasting crisis in severe cases, advanced bone age. | Serum 17-hydroxyprogesterone (elevated), serum electrolytes, genetic testing for CYP21A2 mutation, adrenal ultrasound. | Glucocorticoid replacement therapy, mineralocorticoid replacement if salt-wasting form, monitoring of growth and development, surgical management of genital ambiguity if needed. |
Gonadal Tumours | Asymmetric breast development, rapid growth, early pubic hair, abdominal mass if gonadal tumour is present, virilization in girls or feminization in boys. | Serum estradiol/testosterone (elevated), ultrasound or MRI of the pelvis, serum tumour markers (e.g., AFP, hCG), bone age assessment. | Surgical resection of the tumour, chemotherapy or radiotherapy if indicated, monitoring for recurrence, hormone therapy if necessary. |
Exogenous Hormone Exposure | Early development of secondary sexual characteristics without other signs of puberty progression, exposure history to external hormones (e.g., creams, medications). | Serum estradiol/testosterone (elevated), review of medication history, assessment for possible sources of hormone exposure. | Discontinuation of exogenous hormone sources, education on avoiding exposure, monitoring for regression of pubertal signs. |
Primary Hypothyroidism | Delayed growth, precocious puberty, delayed bone age, goiter, symptoms of hypothyroidism (fatigue, constipation, weight gain). | Serum TSH (elevated), free T4 (low), bone age assessment, thyroid ultrasound if goiter is present. | Thyroid hormone replacement therapy (levothyroxine), monitoring for resolution of precocious puberty signs and normalization of growth. |
Familial (Constitutional) | Early but normal progression of puberty, family history of early puberty, normal growth velocity and bone age. | Growth charts, family history assessment, bone age assessment, serum LH and FSH (normal). | Reassurance and monitoring, no specific treatment needed, regular follow-up to ensure normal pubertal progression. |